Health insurance in Arizona
- Arizona residents use HealthCare.gov to enroll in exchange plans
- Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
- Short-term health plans are can be sold in Arizona with terms of up to 364 days and total duration, including renewals, of up to three years. This is a rule change that took effect in August 2019 in the state, following implementation of a new state law.
- Five insurers are offering plans for 2020.
- Arizona’s uninsured rate has dropped by 38% since 2013, but is still higher than the national average.
- Overall exchange enrollment continued to drop, falling to 153,000 for 2020 coverage, which is down about 25% from peak enrollment in 2016.
- Arizona has expanded Medicaid, but has obtained federal approval for a Medicaid work requirement. The state has delayed implementation of the work requirement, however, amid ongoing legal challenges across the country.
- More than 1.3 million Arizona residents are enrolled in Medicare.
- Arizona’s congressional delegation tilts slightly in favor of the ACA.
Arizona’s health insurance marketplace
Arizona uses the federally facilitated exchange, so residents enroll through HealthCare.gov. Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
Arizona made headlines in the fall of 2016, due to the number of insurers leaving the exchange and the significant rate increases for 2017. But for 2018, Arizona had among the smallest rate increases in the country, with rates virtually unchanged from 2017.
Enrollment in QHPs through the Arizona exchange has dropped by 25% since 2016
During 2016 open enrollment, 203,066 people enrolled in private health plans through Arizona’s exchange. Enrollment has declined each year since then, and only 153,020 people signed up for private individual market plans through Arizona’s exchange during the open enrollment period for 2020 coverage. That’s nearly a 25 percent reduction in enrollment in four years.
Medicaid in Arizona
Arizona Medicaid is called AHCCCS, for Arizona Health Care Cost Containment System.
Former Gov. Brewer followed a different course than most Republican governors and pushed hard for Medicaid expansion in Arizona. A bill authorizing expansion was passed with some Republican support and signed into law by Brewer in 2013.
However, the expansion has been repeatedly challenged. The Arizona legislature in February 2015 passed SB1092, which requires the state to seek an annual waiver from CMS to allow additional eligibility restrictions for Arizona’s Medicaid program – Arizona Health Care Cost Containment System (AHCCCS, which is pronounced “access”). Gov. Ducey signed the bill into law in March 2015.
In September 2016, the Obama Administration CMS approved Arizona’s waiver proposal, but eliminated the most conservative aspects of it. The new waiver runs through September 2021. It implemented a requirement for modest health savings account contributions from enrollees with income above the poverty level, and enrollment in an optional (rather than mandatory) job search program.
Under the Obama Administration, CMS did not allow Arizona to implement a work requirement, limit AHCCCS coverage for able-bodied adults to five years, or to charge premiums for people with income below the poverty level. The state also cannot lock people out of AHCCCS for six months if they miss a health savings account contribution, or charge fees for missed health care appointments.
However, the Trump Administration is much more open to the sort of proposals that Arizona made in previous years, and a new Arizona Medicaid waiver received partial CMS approval in early 2019. The new waiver allows the state to impose a Medicaid work requirement (which the state has indefinitely postponed), but CMS did not approve the state’s proposal to limit total Medicaid coverage for able-bodied enrollees to five years.
Arizona saw a 45 percent increase in monthly Medicaid/CHIP enrollment from 2013 to November 2016. But enrollment plateaued by 2016 (as was the case in most states), and net enrollment was up 43 percent as of late 2019 — slightly lower than it had been two years earlier. Nationally, Medicaid enrollment is up about 26 percent from where it was in 2013.
Learn more about Arizona’s Medicaid program at the Arizona Health Care Cost Containment System website.
Read more about Medicaid expansion in Arizona.
Short-term health insurance in Arizona
Arizona changed its rules for short-term health plans in 2019, allowing them to follow federal rules instead of the stricter rules the state had previously imposed. So short-term plans in Arizona can have initial terms of up to 364 days, and total duration, including renewals, of up to three years.
Read more about short-term health insurance in Arizona.
How has Obamacare helped Arizona’s uninsured?
Arizona participates in the federally facilitated marketplace (HealthCare.gov) and has expanded its Medicaid program under the ACA.
According to U.S. Census data, 17.1 percent of Arizona residents were uninsured in 2013, and that had dropped to 10.1 percent by 2017, although it crept back up to 10.6 percent by 2018. Nationwide there has been a gradual increase in the uninsured rate under the Trump Administration.
While Arizona’s uninsured rate improved with Obamacare in effect, it’s still above the national average (8.9 percent in 2018).
Arizona lawmakers and the Affordable Care Act
Arizona’s Senate delegation includes Kyrsten Sinema, a Democrat, and Martha McSally, a Republican. Sinema believes the ACA should remain in place but be fixed where necessary, whereas McSally has worked to repeal the ACA. Sinema and McSally were both in the House in 2017 when Republican lawmakers tried to repeal the ACA with the American Health Care Act. McSally voted in favor of the act, while Sinema voted against it.
In the 2010 election, Arizona voters approved a state constitutional amendment barring any state rules or regulations that would force state residents to participate in a healthcare system. Federal law supersedes state law, so the ACA’s individual mandate still applies in Arizona, although the penalty for non-compliance was repealed as of 2019.
Despite opposing the ACA in general, former Governor Jan Brewer was in favor of state-run health insurance exchange and said it was preferable to a one-size-fits-all model imposed by the federal government. To that end, Brewer established the Office of Health Insurance Exchange, and the state took numerous steps toward setting up a state-run exchange. However, state legislators and a public majority remaining opposed. Brewer ultimately bowed to public sentiment and defaulted to the federally facilitated marketplace.
Doug Ducey, a Republican, took over the governor’s office in January 2015, and won re-election in 2018. During his campaign, he described himself as “100 percent opposed to Obamacare.” Within months of taking office, he signed House Bill 2643 into law, effectively banning the state from creating a state-run exchange. So Arizona, like most states, continues to use HealthCare.gov.
Brewer was one of several Republican Governors who supported Medicaid expansion despite opposing the ACA in general. Ultimately, Arizona did opt to expand Medicaid under the Affordable Care Act, and Medicaid enrollment in Arizona is 43 percent higher than it was in 2013.
Medicare enrollment in the state of Arizona
As of late 2019, more than 1.3 million Arizonans were enrolled in Medicare coverage. You can read more about Medicare in Arizona, including details about Medicare Advantage and Part D plans, as well as the state’s rules for Medigap (Medicare Supplement) plans.
Arizona health insurance resources
Arizona health reform legislation
Here’s what’s happened recently in terms of state-level health care reform legislation in Arizona:
- Gov. Ducey signed HB2643 into law in April 2015. The legislation effectively bans the state from creating a state-run exchange.
- Also in 2015, SB1092 was signed into law, requiring the state to continue to ask CMS to approve eligibility changes for Medicaid, including a work requirement and a five-year lifetime coverage limit. The Obama Administration rejected most of the major changes that the state wanted to make, but a new waiver proposal, submitted in late 2017, gained partial approval from the Trump administration.
Scroll to the bottom of this page for a round-up of other healthcare reform legislation at the state level in Arizona.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.